Vaginitis Due to Vaginal Infections, NIAID Fact Sheet: NIAID

Vaginitis Due to Vaginal Infections

Vaginitis is an inflammation of the vagina characterized by
discharge, odor, irritation, and/or itching. The cause of vaginitis
may not always be determined adequately solely on the basis of
symptoms or a physical examination. For a correct diagnosis, a
doctor should perform laboratory tests including microscopic
evaluation of vaginal fluid. A variety of effective drugs are
available for treating vaginitis.

Vaginitis often is caused by infections, which cause distress and
discomfort. Some infections are associated with more serious
diseases. The most common vaginal infections are bacterial
vaginosis, trichomoniasis, and vaginal yeast infection or
candidiasis. Some vaginal infections are transmitted through sexual
contact, but others such as yeast infections probably are not,
depending on the cause.

Bacterial Vaginosis

Bacterial vaginosis (BV) is the most common cause of vaginitis
symptoms among women of childbearing age. Previously called
nonspecific vaginitis or Gardnerella-associated vaginitis,
BV is associated with sexual activity. BV reflects a change in the
vaginal ecosystem. This imbalance, including pH changes, occurs
when different types of bacteria outnumber the normal ones.
Instead of Lactobacillus bacteria being the most numerous,
increased numbers of organisms such as Gardnerella vaginalis,
Bacteroides, Mobiluncus, and Mycoplasma hominis are
found in the vaginas of women with BV. Investigators are studying
the role that each of these microbes may play in causing BV, but
they do not yet understand the role of sexual activity in
developing BV. A change in sexual partners and douching may
increase the risk of acquiring bacterial vaginosis.

Symptoms. The primary
symptom of BV is an abnormal, odorous vaginal discharge. The
fish-like odor is noticeable especially after intercourse. Nearly
half of the women with clinical signs of BV, however, report no
symptoms. A physician may observe these signs during a physical
examination and may confirm the diagnosis by doing tests of
vaginal fluid.

Diagnosis. A
healthcare worker can examine a sample of vaginal fluid under a
microscope, either stained or in special lighting, to detect the
presence of the organisms associated with BV. They can make a
diagnosis based on the absence of lactobacilli, the presence of
numerous "clue cells" (cells from the vaginal lining that are
coated with BV organisms), a fishy odor, and decreased acidity or
change in pH of vaginal fluid.

Treatment. All women
with BV should be informed of their diagnoses, including the
possibility of sexual transmission, and offered treatment. They
can be treated with antibiotics such as metronidazole or
clindamycin. Generally, male sex partners are not treated. Many
women with symptoms of BV do not seek medical treatment, and many
asymptomatic women decline treatment.

Complications.
Researchers have shown an association between BV and pelvic
inflammatory disease (PID), which can cause infertility and tubal
(ectopic) pregnancy. BV also can cause adverse outcomes of
pregnancy such as premature delivery and low-birth-weight infants.
Therefore, the U.S. Centers for Disease Control and Prevention
(CDC) recommends that doctors check all pregnant women for BV who
previously have delivered a premature baby, whether or not the
women have symptoms. If these women have BV, they should be
treated with oral metronidazole or oral clindamycin. A pregnant
woman who has not delivered a premature baby should be treated if
she has symptoms and laboratory evidence of BV. BV is also
associated with increased risk of gonorrhea and HIV infection
(HIV, human immunodeficiency virus, causes AIDS).

Trichomoniasis

Trichomoniasis, sometimes referred to as "trich," is a common
STD that affects 2 to 3 million Americans yearly. It is caused by
a single-celled protozoan parasite called Trichomonas
vaginalis. Trichomoniasis is primarily an infection of the
urogenital tract; the urethra is the most common site of infection
in man, and the vagina is the most common site of infection in
women.

Symptoms.
Trichomoniasis, like many other STDs, often occurs without any
symptoms. Men almost never have symptoms. When women have
symptoms, they usually appear within four to 20 days of exposure.
The symptoms in women include a heavy, yellow-green or gray
vaginal discharge, discomfort during intercourse, vaginal odor,
and painful urination. Irritation and itching of the female
genital area, and on rare occasions, lower abdominal pain also can
be present. The symptoms in men, if present, include a thin,
whitish discharge from the penis and painful or difficult
urination.

Treatment. Because men
can transmit the disease to their sex partners even when symptoms
are not present, it is preferable to treat both partners to
eliminate the parasite. Metronidazole is the drug used to treat
people with trichomoniasis. It usually is administered in a single
dose. People taking this drug should not drink alcohol because
mixing the two substances occasionally can cause severe nausea and
vomiting.

Complications.
Research has shown a link between trichomoniasis and two serious
sequelae. Data suggest that trichomoniasis is associated with
increased risk of transmission of HIV and may cause a woman to
deliver a low-birth-weight or premature infant. Additional
research is needed to fully explore these relationships.

Prevention. Use of
male condoms may help prevent the spread of trichomoniasis,
although careful studies have never been done that focus on how to
prevent this infection.

Vaginal Yeast Infection

Vaginal yeast infection or vulvovaginal candidiasis is a common
cause of vaginal irritation. Doctors estimate that approximately
75 percent of all women will experience at least one symptomatic
yeast infection during their lifetimes. Yeast are always present
in the vagina in small numbers, and symptoms only appear with
overgrowth. Several factors are associated with increased
symptomatic infection in women, including pregnancy, uncontrolled
diabetes mellitus, and the use of oral contraceptives or
antibiotics. Other factors that may increase the incidence of
yeast infection include using douches, perfumed feminine hygiene
sprays, and topical antimicrobial agents, and wearing tight,
poorly ventilated clothing and underwear. Whether or not yeast can
be transmitted sexually is unknown. Because almost all women have
the organism in the vagina, it has been difficult for researchers
to study this aspect of the natural history.

Symptoms. The most
frequent symptoms of yeast infection in women are itching,
burning, and irritation of the vagina. Painful urination and/or
intercourse are common. Vaginal discharge is not always present
and may be minimal. The thick, whitish-gray discharge is typically
described as cottage-cheese-like in nature, although it can vary
from watery to thick in consistency. Most male partners of women
with yeast infection do not experience any symptoms of the
infection. A transient rash and burning sensation of the penis,
however, have been reported after intercourse if condoms were not
used. These symptoms are usually self-limiting.

Diagnosis. Because few
specific signs and symptoms are usually present, this condition
cannot be diagnosed by the patient's history and physical
examination. The doctor usually diagnoses yeast infection through
microscopic examination of vaginal secretions for evidence of
yeast forms.

Scientists funded by the National Institute of Allergy and
Infectious Diseases (NIAID) have developed a rapid simple test for
yeast infection, which will soon be available for use in doctorsí
offices. If such a test were available for home screening, it
would help them to appropriately use yeast medication.

Treatment. Various
antifungal vaginal medications are available to treat yeast
infection. Women can buy some antifungal creams, tablets, or
suppositories (butoconazole, miconazole, clotrimazole, and
tioconazole) over the counter for use in the vagina. But because
BV, trichomoniasis, and yeast infection are difficult to
distinguish on the basis of symptoms alone, a woman with vaginal
symptoms should see her physician for an accurate diagnosis before
using these products.

Other products available over the counter contain
antihistamines or topical anesthetics that only mask the symptoms
and do not treat the underlying problem. Women who have chronic or
recurring yeast infections may need to be treated with vaginal
creams for extended periods of time. Recently, effective oral
medications have become available. Women should work with their
physicians to determine possible underlying causes of their
chronic yeast infections. HIV-infected women may have severe yeast
infections that are often unresponsive to treatment.

Other Causes of Vaginitis

Although most vaginal infections in women are due to bacterial
vaginosis, trichomoniasis, or yeast, there may be other causes as
well. These causes may include allergic and irritative factors or
other STDs. Noninfectious allergic symptoms can be caused by
spermicides, vaginal hygiene products, detergents, and fabric
softeners. Cervical inflammation from these products often is
associated with abnormal vaginal discharge, but can be
distinguished from true vaginal infections by appropriate
diagnostic tests.

In an effort to control vaginitis, research is under way to
determine the factors that promote the growth and disease-causing
potential of vaginal microbes. No longer considered merely a
benign annoyance, vaginitis is the object of serious investigation
as scientists attempt to clarify its role in such conditions as
pelvic inflammatory disease and pregnancy-related complications.

NIAID, a component of the National Institutes of Health,
supports research on AIDS, malaria, tuberculosis and other
infectious diseases, as well as allergies and immunology.

Prepared by: Office of Communications and Public
LiaisonNational Institute of Allergy and Infectious
DiseasesNational Institutes of HealthBethesda, MD 20892

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